Provider Demographics
NPI:1578278867
Name:BURKE-LYONS, KEMOY BEVERLINE (LPN)
Entity Type:Individual
Prefix:
First Name:KEMOY
Middle Name:BEVERLINE
Last Name:BURKE-LYONS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31A WORKSHOP RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-1210
Mailing Address - Country:US
Mailing Address - Phone:508-398-5155
Mailing Address - Fax:508-398-3478
Practice Address - Street 1:31A WORKSHOP RD
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1210
Practice Address - Country:US
Practice Address - Phone:508-398-5155
Practice Address - Fax:508-398-3478
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN100190164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALN100190Medicaid